Book Review - Internal Medicine - A Doctor's Stories

This ‘collection of essays about life as a surgical intern’ showcases the US author’s parallel skills as essayist and medical specialist (geriatrics).

His previous work, In the Valley of the Kings, ranged across suspense, horror, absurdism, and more, no doubt qualities seen in ample measure in large hospitals. This time around, rather than looking to ancient Egypt (hence the title) or outer space (the setting for several tales), Dr Holt has turned his attention to non-fiction and events within his workplace, and fascinating stories have resulted.

We are by his side as he struggles to persuade a 47-year-old claustrophobic respiratory patient that a face mask will save her life. As he discusses end-of-life options with the huge, highly religious family of a dying patient. On the road with a palliative care service making home visits to a talented bird artist, suffering advanced facial cancer.

Typically, the patients at his North Carolina hospital are elderly, although the mix includes the younger unwell, and those with self-inflicted harm – the ‘Iron Maiden’ who has swallowed needles, and a young woman who arrives in ED with a massive, potentially fatal, overdose of Tylenol, commonly known by its non-proprietary name, paracetamol.

“I introduced myself… She didn’t look too sick. “I hope you won’t think I’m bad,” she drawled. She said this with a sly half smile, waiting for a reaction. It was such an odd thing to say that I paused.

“Why would I think that?’

“She shrugged, still smiling. “I don’t know.” And slowly she slid back down to the bed.”

The alarm sounded when the patient’s liver chemistries came back, the figures through the roof.

“In a flash I knew what was doing it, as certainly as I knew where it would end… I knew what had destroyed her liver, I knew it as surely as I knew that, for all practical purposes, Ariel Crawley was already dead.”

In fact she was not, for a liver was transplanted from “the helmetless passenger of a wrecked motorcycle” and her life was saved.

“I lost eight patients that month,” Holt recalls, “and Ariel wasn’t one of them. She got a second chance. A victory of sorts.”

Wins may not be common, but even in the losses, the human spirit and the clinician’s compassion comes through.